P1096: TREATMENT OF HEPATITIS C-ASSOCIATED MARGINAL ZONE LYMPHOMA(HCV+LMZ) WITH DIRECT-ACTING ANTIVIRAL DRUGS (DAAS)
Authors: Sergey Lepkov, Gayne Tumyan, Oleg Kolomeytsev, Svetlana Lunina, Anastasia Semenova, Natalia Kuprihina, Daria Tupicina, Natalia Kokosadze, Svetlana Borisovckay, Natalia Gavrilina, Kira Savkina, Roman Ivashenko, Olga Manuilova, Oleg Zaharov, Natalia Chernova, Maria Blagova, Efim Pozharskiy, Julia Ribukina, Vladimir Lazarev, Olga Ettinger, Igor Nikitin
Journal: HemaSphere (2023)

Topic: 18. Indolent and mantle-cell non-Hodgkin lymphoma - Clinical Background: HCV is involved in the oncogenesis of a number of malignant non-Hodgkin’s lymphomas. HCV+ MZL associated with chronic hepatitis C infection. There are a number of unresolved issues in the treatment of pts with HCV+ MZL: 1 start with antiviral therapy(AT) or immunochemotherapy; 2 If with AT, what to start in the first line of AT: interferon ribaverin or direct-acting antiviral drugs (DAAs)? Or a combination of DAAs and interferon. Data on the effectiveness of DAAs and long-term results of treatment of pts with HCV+ MZL are limited. Aims: The aim of our work was to conduct a prospective study to evaluate the efficacy of DAAs on both virus elimination and antitumor response. To evaluate the possibility of enhancing the antitumor effect of DAAs. Methods: Twenty-three HCV+ MZL pts were included in our study. The median age was 54 years (31-75 years), 47% male, stage III-IV were in 19(82%) pts, B-symptoms were in 8 (35%). Spleen and bone marrow lesions were 14(61%)pts, liver lesions were 13(56%). Elevated ALT levels were in 21(91%) pts, AST in 16(69%), GGTP in 8(35%) LDH in 21(91%). Reduced platelet (PT)count was in 16(69%) pts, red blood cell count was reduced in 9(39%) pts. Liver cirrhosis was in 4(17%)pts. Genotype 1 was in 17(74%), genotype 2 + 3 in 6(26%) pts. Previously published results Blood. 2022 Feb 3;139(5):732-747. indicate that the HCV+ MZL group was significantly younger, had more advanced stages, and bone marrow and liver lesions were more common. Elevations of ALT, AST, GGTP, LDH were also significantly higher in the HCV+ MZL pts. Reduced erythrocyte and PT levels were significantly more common in the HCV+ MZL pts. All pts started treatment with DAAs (sofosbuvir + lidipasvir or sofosbuvir + valpatosvir). The duration of therapy was 6 to 8 mths. Results: Complete elimination of the virus was observed in all 23 (100%) pts. The maximum time to achieve virologic remission was 2 mths. The overall rate of antitumor response (complete + partial remissions of CR + PR) on DAA therapy was obtained in 14(62%) pts. The median achievement of remission was 4.5 mths. In 9 pts with splenomegaly (more than 18 cm) only tumor stabilization was achieved. INF was combined to DAA therapy in these 9 pts. CR+PR was achieved in 7 of 9 pts. The overall 4-year survival rate was 92%. The 4-year PFS was 62%. Summary/Conclusion: AT is the preferred first-line therapy in pts with HCV+MZL. Because of its safety, the rate of complete virologic response, DAAs should be considered first-line therapy. If there is no antitumor effect from DAAs, IFNs may be combined. Keywords: Low-grade NHL, Hepatitis C virus